1710238530 NPI number — MS. REBECCA N STOLL CRNA

Table of content: MS. REBECCA N STOLL CRNA (NPI 1710238530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710238530 NPI number — MS. REBECCA N STOLL CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOLL
Provider First Name:
REBECCA
Provider Middle Name:
N
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHERMERHORN
Provider Other First Name:
REBECCA
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710238530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1236 E ELIZABETH ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80524-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-224-2985
Provider Business Mailing Address Fax Number:
970-472-9381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1236 E ELIZABETH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-224-2985
Provider Business Practice Location Address Fax Number:
970-472-9381
Provider Enumeration Date:
09/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  APN.0990519-CRNA , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01207555 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01126149 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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